🔄 The Menstrual Cycle with PMDs
The menstrual cycle is more than just a period; it's a complex hormonal rhythm that can have a significant emotional and physical impact, especially for those living with Premenstrual Disorders (PMDs). Below is an overview of the cycle phases, including what people with PMDD may experience.
Menstrual Phase (Day 1–5)
🩸 Your period begins.
The uterine lining sheds, leading to bleeding.
Estrogen and progesterone levels are at their lowest.
🔴 PMDD
This phase often brings relief. Symptoms may lift quickly or gradually after menstruation begins, and this “symptom-free window” can feel like returning to yourself. Some may feel physically drained or emotionally raw from the previous luteal phase.
🌀 PME
Some people feel relief during this time, while others may still experience symptoms related to their underlying condition (e.g., fatigue, pain, low mood). Symptoms usually return to baseline levels during this phase. But unlike PMDD, they don’t vanish completely.
Follicular Phase (Day 1–13)
🌱 Recovery, energy, and hope.
Overlaps with the menstrual phase at first.
The brain signals the ovaries to develop follicles, each containing an egg.
The body begins building a new uterine lining.
Estrogen levels gradually rise, supporting improved mood, focus, and motivation.
🔴 PMDD
Many report this phase as their best time of the month, often referred to as the “good weeks.” It’s a time when they may feel most like themselves: productive, social, and emotionally stable. However, some remain anxious about what’s to come, known as anticipatory anxiety.
🌀 PME
This can be a “better” phase. People with PME may experience more manageable symptoms or even brief periods of improvement. However, underlying conditions (like anxiety or depression) don’t disappear; they're just less intense.
Ovulation (Around Day 14)
🟡 Hormonal peak and change.
A spike in luteinizing hormone (LH) triggers the release of an egg.
Estrogen peaks, then drops suddenly after ovulation, while progesterone begins to rise.
This is the most fertile time of the cycle.
Some people feel a slight twinge or cramping (called mittelschmerz).
🔴 PMDD
This hormonal shift can be a turning point. Some may notice subtle mood changes, physical symptoms, irritability, or fatigue soon after ovulation. This is when PMDD symptoms often begin to emerge.
🌀 PME
This hormonal shift can be a turning point. Some may notice subtle mood changes, physical symptoms, irritability, or fatigue soon after ovulation. This is when PME symptoms often begin to emerge.
Luteal Phase (Day 15–28)
🌩️ The storm of PMDD.
Estrogen drops.
After ovulation, progesterone increases to prepare the uterus for a possible pregnancy.
Progesterone rises, peaks, and dominates while estrogen stays low.
If pregnancy doesn’t occur, both estrogen and progesterone levels drop sharply at the end of this phase before your period starts.
🔴 PMDD
This phase is when symptoms peak, including rage, despair, anxiety, fatigue, and intrusive thoughts. Many experience turning off emotional shifts and may struggle with relationships, work, and daily functioning. For some, this time can bring suicidal thoughts or self-harming urges. Symptoms typically begin to lift after bleeding starts.
🌀 PME
This is when symptoms worsen most significantly. The underlying condition flares, often causing:
→ Increased depression, anxiety, irritability, or intrusive thoughts
→ Trouble concentrating or sleeping
→ Stronger physical pain, fatigue, or sensory issues
→ Emotional dysregulation or hopelessness
🔄 Then the cycle repeats.
🔄 Why Tracking Matters
Because PMDD symptoms are cyclical, it is crucial to understand your personal patterns, especially in relation to ovulation and the luteal phase. Using tools like the IAPMD PMDs Symptom Tracker, which includes the validated DRSP, helps you see your cycle clearly and advocate for appropriate care.
PMDD cannot be diagnosed through blood, hormone, or saliva tests. While these tests can help rule out other underlying conditions, such as hormone imbalances or thyroid disorders, they cannot confirm a PMDD diagnosis. The only current method for diagnosing PMDD is by tracking symptoms daily over the course of at least two menstrual cycles.
Please print out the tracking sheets and complete them daily for at least two full menstrual cycles. Bring the completed charts to healthcare appointments to support evaluation, diagnosis, and treatment planning.